Global, regional, and national burden of stroke and its risk factors, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021.

IF 46.5 1区 医学 Q1 CLINICAL NEUROLOGY Lancet Neurology Pub Date : 2024-10-01 DOI:10.1016/S1474-4422(24)00369-7
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Abstract

Background: Up-to-date estimates of stroke burden and attributable risks and their trends at global, regional, and national levels are essential for evidence-based health care, prevention, and resource allocation planning. We aimed to provide such estimates for the period 1990-2021.

Methods: We estimated incidence, prevalence, death, and disability-adjusted life-year (DALY) counts and age-standardised rates per 100 000 people per year for overall stroke, ischaemic stroke, intracerebral haemorrhage, and subarachnoid haemorrhage, for 204 countries and territories from 1990 to 2021. We also calculated burden of stroke attributable to 23 risk factors and six risk clusters (air pollution, tobacco smoking, behavioural, dietary, environmental, and metabolic risks) at the global and regional levels (21 GBD regions and Socio-demographic Index [SDI] quintiles), using the standard GBD methodology. 95% uncertainty intervals (UIs) for each individual future estimate were derived from the 2·5th and 97·5th percentiles of distributions generated from propagating 500 draws through the multistage computational pipeline.

Findings: In 2021, stroke was the third most common GBD level 3 cause of death (7·3 million [95% UI 6·6-7·8] deaths; 10·7% [9·8-11·3] of all deaths) after ischaemic heart disease and COVID-19, and the fourth most common cause of DALYs (160·5 million [147·8-171·6] DALYs; 5·6% [5·0-6·1] of all DALYs). In 2021, there were 93·8 million (89·0-99·3) prevalent and 11·9 million (10·7-13·2) incident strokes. We found disparities in stroke burden and risk factors by GBD region, country or territory, and SDI, as well as a stagnation in the reduction of incidence from 2015 onwards, and even some increases in the stroke incidence, death, prevalence, and DALY rates in southeast Asia, east Asia, and Oceania, countries with lower SDI, and people younger than 70 years. Globally, ischaemic stroke constituted 65·3% (62·4-67·7), intracerebral haemorrhage constituted 28·8% (28·3-28·8), and subarachnoid haemorrhage constituted 5·8% (5·7-6·0) of incident strokes. There were substantial increases in DALYs attributable to high BMI (88·2% [53·4-117·7]), high ambient temperature (72·4% [51·1 to 179·5]), high fasting plasma glucose (32·1% [26·7-38·1]), diet high in sugar-sweetened beverages (23·4% [12·7-35·7]), low physical activity (11·3% [1·8-34·9]), high systolic blood pressure (6·7% [2·5-11·6]), lead exposure (6·5% [4·5-11·2]), and diet low in omega-6 polyunsaturated fatty acids (5·3% [0·5-10·5]).

Interpretation: Stroke burden has increased from 1990 to 2021, and the contribution of several risk factors has also increased. Effective, accessible, and affordable measures to improve stroke surveillance, prevention (with the emphasis on blood pressure, lifestyle, and environmental factors), acute care, and rehabilitation need to be urgently implemented across all countries to reduce stroke burden.

Funding: Bill & Melinda Gates Foundation.

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1990-2021 年全球、地区和国家中风负担及其风险因素:2021 年全球疾病负担研究的系统分析。
背景:全球、地区和国家层面对卒中负担和可归因风险及其趋势的最新估计对于循证医疗、预防和资源分配规划至关重要。我们旨在提供 1990-2021 年期间的此类估计值:我们估算了 1990 年至 2021 年期间 204 个国家和地区的发病率、流行率、死亡率、残疾调整生命年(DALY)计数以及每年每 10 万人中总中风、缺血性中风、脑出血和蛛网膜下腔出血的年龄标准化比率。我们还采用标准的 GBD 方法计算了全球和地区水平(21 个 GBD 地区和社会人口指数(SDI)五分位数)上 23 个风险因素和 6 个风险群(空气污染、吸烟、行为、饮食、环境和代谢风险)导致的中风负担。每个单个未来估计值的 95% 不确定性区间 (UI) 是通过多级计算管道传播 500 次抽样所产生的分布的第 2-5 百分位数和第 97-5 百分位数得出的:2021 年,中风是继缺血性心脏病和 COVID-19 之后第三大最常见的 GBD 3 级死因(7-300 万 [95% UI 6-6-7-8]例死亡;占总死亡人数的 10-7% [9-8-11-3]),也是第四大最常见的残疾调整寿命年(160-500 万 [147-8-171-6] 个残疾调整寿命年;占总残疾调整寿命年的 5-6% [5-0-6-1])。2021 年,将有 9,300-800 万 (89-0-99-3) 流行性中风和 1,190-900 万 (10-7-13-2) 事故性中风。我们发现,按 GBD 地区、国家或地区和 SDI 划分,脑卒中负担和风险因素存在差异,而且从 2015 年起,发病率的下降停滞不前,在东南亚、东亚和大洋洲、SDI 较低的国家以及 70 岁以下人群中,脑卒中发病率、死亡率、患病率和残疾调整寿命年数率甚至有所上升。在全球范围内,缺血性脑卒中占脑卒中发病率的 65-3%(62-4-67-7),脑内出血占 28-8%(28-3-28-8),蛛网膜下腔出血占 5-8%(5-7-6-0)。高体重指数(88-2% [53-4-117-7])、高环境温度(72-4% [51-1-179-5])、高空腹血浆葡萄糖(32-1% [26-7-38-1])、高含糖饮料饮食(23-4% [12-7-35-7])导致残疾调整寿命年数大幅增加、低运动量(11-3% [1-8-34-9])、高收缩压(6-7% [2-5-11-6])、铅暴露(6-5% [4-5-11-2])和低ω-6 多不饱和脂肪酸饮食(5-3% [0-5-10-5])。解释:从 1990 年到 2021 年,脑卒中的负担有所加重,一些风险因素的作用也有所增加。所有国家都急需采取有效、方便、负担得起的措施来改善中风监测、预防(重点是血压、生活方式和环境因素)、急性期护理和康复,以减轻中风负担:比尔及梅林达-盖茨基金会。
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来源期刊
Lancet Neurology
Lancet Neurology 医学-临床神经学
CiteScore
58.70
自引率
1.00%
发文量
572
审稿时长
6-12 weeks
期刊介绍: The Lancet Neurology is the world-leading clinical neurology journal. It publishes original research that advocates for change in, or sheds light on, neurological clinical practice. The topics covered include cerebrovascular disease, Alzheimer's disease and other dementias, epilepsy, migraine, neurological infections, movement disorders, multiple sclerosis, neuromuscular disorders, peripheral nerve disorders, pediatric neurology, sleep disorders, and traumatic brain injury. The journal publishes a range of article types, including Articles (including randomized clinical trials and meta-analyses), Review, Rapid Review, Comment, Correspondence, and Personal View. It also publishes Series and Commissions that aim to shape and drive positive change in clinical practice and health policy in areas of need in neurology. The Lancet Neurology is an internationally trusted source of clinical, public health, and global health knowledge. It has an Impact Factor of 48.0, making it the top-ranked clinical neurology journal out of 212 journals worldwide.
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